Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
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Case Reports
[Atrial septum rupture following blunt thoracic injury within the scope of polytrauma].
Blunt thoracic trauma is a frequent diagnosis in polytraumatic patients, blunt cardiac trauma a rare finding. Severe cardiac injuries e.g. myocardial rupture normally result in immediate death of the patients. If patients survive a cardiac trauma, it often remains unrecognized. ⋯ A case report of a traumatic atrial septal defect with left to right shunting due to blunt thoracic trauma in a young man is presented. To our knowledge this is the second case of a successfully repaired traumatic atrial septal defect in literature. Problems regarding diagnosis of the less commonly observed blunt cardiac traumas are discussed.
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The incidence of postoperative delirium was assessed in 92 patients on a general surgical intensive care unit. Postoperative delirium was diagnosed in 39 patients (42%). Most of the cases were diagnosed on the second postoperative day and the median duration was seven days. ⋯ In univariate analysis the variables age, preoperative therapy for heart failure, respirator therapy, dobutamin therapy and lowest capillary pO2 on day one were significantly associated with later development of delirium, whereas preoperative peritonitis, and history of stroke or hypertension were only borderline significant. A predictive model with three parameters emerged from multiple logistic regression analysis: after correction for age (p = 0.001), respirator therapy (p = 0.020), and capillary pO2 on day one (p = 0.049) none of the remaining variables proved of additional significance. The statistical model yielded a predictive accuracy of 78%.
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Case Reports
[Accidental drowning with extreme hypothermia--rewarming with extracorporeal circulation].
A 3 1/2 year old boy had fallen into a fishpond. After about one hour the boy was brought to our hospital. ⋯ Via a sternotomy the heart lung machine was connected and core rewarming was achieved. After 7 days of artificial respiration the boy could be extubated, after 16 days the boy left our hospital without neurological consequences.